Reducing mounting Lassa fever casualties

The rash of deaths recorded across the country in the wake of the ongoing Lassa fever epidemic is evidence that not much has changed over the years in the management and control of the disease in Nigeria. If any lessons have been learnt at all from previous experiences, they are obviously not being put to proper use to contain the high incidence of the deadly disease. Instead of witnessing a decline in yearly infection rates, Lassa fever cases appear to have become more widespread in the country.

Although figures appear to be understated, reports have it that 31 deaths have already been recorded from 105 laboratory confirmed cases of the disease in 15 states across the country in the current outbreak. More cases are still being recorded on a daily basis. For a disease that is not so strange to the country’s health authorities, there should be better ways of handling it to reasonably bring down the casualty figures. In particular, health care workers, as professionals, should take their self protection more seriously to reduce the soaring number of casualties among them.

Between December 2016 and June 9, 2017, a total of 501 suspected cases of Lassa fever were reported in the country, with the death toll put at 104. With two deaths also recorded in Lagos, the destructive impact of the disease was felt in no fewer than 18 states, both in the northern and southern parts of the country.

Lassa fever is a disease known to be endemic in Nigeria and many other West African countries, where cases of infection reach between 300,000 and 500,000 yearly, resulting in some 5,000 deaths, according to the World Health Organisation. But despite the annual harvest of deaths, there has not been a well-coordinated, determined and focused effort to reduce the casualty rate and, possibly, eradicate the disease. For a disease that is both curable, if early medical intervention is sought, and preventable through observance of adequate personal hygiene, this is not good enough. Indeed, the figures are alarming and it is getting to a stage where the government can ill afford to continue to ignore them.

An acute viral haemorrhagic disease, common mostly during the dry season, Lassa fever could, however, strike at any time of the year, with health care workers as some of the most vulnerable victims. During a recent protest march by members of the Nigerian Medical Association, Ebonyi State chapter, the doctors lamented that no fewer than 40 health care workers had been killed in the state by the disease in the last 13 years. Already, two doctors and a nurse have died of the disease this year in the state. This is quite high in a part of the world where health care givers are still not available in sufficient numbers.

Besides Ebonyi State, the death of a medical doctor has also been reported in Kogi, after he was said to have treated a seven-month-old baby who also died later. Other states that have also reported the death of doctors include Anambra and Ondo, as the disease continues to ravage places such as Edo, Imo, Bauchi, Benue, Gombe, Nasarawa, Ekiti and Delta, among other states.

Lassa fever, caused by Lassa virus, is a zoonotic disease that is contracted through close contact with an infected animal, this time a species of rat called multimammate or Mastomys rat. According to WHO, while the infected rat cannot fall ill, it can shed the virus in its urine or faeces through which infection can occur. Person-to-person transmission is also possible from direct contact with an infected person’s blood, urine, faeces or other bodily secretions.

Symptoms of Lassa fever during the first few days include fever, general weakness and malaise. They are followed later by headache, sore throat, chest pain, vomiting, diarrhoea, abdominal pain and cough. Severe cases present fluid in the lung cavity, facial swelling, bleeding from the mouth, nose and vagina. Gastroenteritis, low blood pressure, seizures, tremor, shock and disorientation are other symptoms that are noticed as the disease progresses. Death occurs within 14 days of onset but for those who survive, 25 per cent suffer deafness, which is restored after one to three months.

Nigeria’s adept handling of the dreaded Ebola Virus Disease in 2014 is often cited as inspiration in the handling of Lassa fever, which has astonishingly similar features with the former. Both are referred to as viral haemorrhagic fevers and are transmitted from animal to man. They also have similar incubation periods of six to 21 days.

In prevention of Lassa fever, it is critical to maintain a high level of hygiene around the home, which could help to keep rats at bay. Apart from keeping the home clean, it is also important for the environment to be kept clean and refuse dumpsites to be far away from residences. This falls under the purview of the local government, which, in the past, had sanitary inspectors that moved from house to house to enforce compliance with accepted standards of cleanliness of the home and the environment. Those whose duty it is to clean the drains should be made to do their job to reduce the breeding ground for rodents.

Unfortunately, when the Senate had cause to debate the issue recently under a motion by Clifford Ordia, the concerns were more about providing care for the sick; not much was said of the preventive measures. Although mention was made of the need to sensitise Nigerians, the greater effort was on equipping the Specialist Hospital in Irrua, Edo State. Of course, it is good to equip hospitals and train doctors, but it is better to try to stop the infection and transmission of the deadly disease. It is obvious that if measures are taken to curtail the breeding of rats, the rate of Lassa fever deaths would be significantly reduced.

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